US20160194379A1 - Regeneration of Damaged Tissue - Google Patents

Regeneration of Damaged Tissue Download PDF

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US20160194379A1
US20160194379A1 US14/911,401 US201414911401A US2016194379A1 US 20160194379 A1 US20160194379 A1 US 20160194379A1 US 201414911401 A US201414911401 A US 201414911401A US 2016194379 A1 US2016194379 A1 US 2016194379A1
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wound
tropoelastin
tissue
edge
epithelialization
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Anthony Steven Weiss
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Allergan Pharmaceuticals International Ltd
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Elastagen Pty Ltd
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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • C07K14/78—Connective tissue peptides, e.g. collagen, elastin, laminin, fibronectin, vitronectin or cold insoluble globulin [CIG]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F13/00—Bandages or dressings; Absorbent pads
    • A61F13/00051—Accessories for dressings
    • A61F13/00063—Accessories for dressings comprising medicaments or additives, e.g. odor control, PH control, debriding, antimicrobic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F13/00—Bandages or dressings; Absorbent pads
    • A61F13/02—Adhesive bandages or dressings
    • A61F13/0203—Adhesive bandages or dressings with fluid retention members
    • A61F13/0213—Adhesive bandages or dressings with fluid retention members the fluid retention member being a layer of hydrocolloid, gel forming material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/39—Connective tissue peptides, e.g. collagen, elastin, laminin, fibronectin, vitronectin, cold insoluble globulin [CIG]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0014—Skin, i.e. galenical aspects of topical compositions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/06—Ointments; Bases therefor; Other semi-solid forms, e.g. creams, sticks, gels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/70—Web, sheet or filament bases ; Films; Fibres of the matrix type containing drug
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/14—Macromolecular materials
    • A61L27/22—Polypeptides or derivatives thereof, e.g. degradation products
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
    • A61L27/3604—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix characterised by the human or animal origin of the biological material, e.g. hair, fascia, fish scales, silk, shellac, pericardium, pleura, renal tissue, amniotic membrane, parenchymal tissue, fetal tissue, muscle tissue, fat tissue, enamel
    • A61L27/3633—Extracellular matrix [ECM]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L27/56—Porous materials, e.g. foams or sponges
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00—Drugs for dermatological disorders
    • A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P41/00—Drugs used in surgical methods, e.g. surgery adjuvants for preventing adhesion or for vitreum substitution
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2400/00—Materials characterised by their function or physical properties
    • A61L2400/06—Flowable or injectable implant compositions

Definitions

  • the invention relates to wound healing, in particular to improvements to re-epithelialization of wounds.
  • Skin is composed of two layers, the epidermis and the dermis, the latter being connected to the fatty underlying structure, the subcutaneous hypodermis.
  • the epidermis is the thinnest and outermost component of the skin, consisting predominantly of keratinocyte cells.
  • the dermis is a dense connective tissue composed of collagen, elastic fibers, and interfibrillar gel of glycosaminoglycans, salts, and water.
  • the epidermis and the dermis are interlocked by downward projecting epidermal rete ridges and upward projecting dermal papillae. They are separated by the basement membrane, a highly specialised form of extracellular matrix (ECM) composed of glycoproteins and proteoglycans.
  • ECM extracellular matrix
  • the dermis consists of two structurally different layers: the superficial, thin papillary dermis and deeper reticular dermis.
  • the papillary dermis consists of connective tissue containing fine elastic fibers and is shaped into small, finger-like projections known as dermal papillae that, as discussed previously, connect the dermis to the epidermis.
  • the reticular dermis comprises dense, irregular connective tissue containing bundles of collagen interlaced into a net-like structure and thick, horizontally aligned elastic fibers.
  • Wound healing is a complex process in which a tissue either repairs or regenerates itself after injury. Some tissues are capable of regeneration, but may tend towards a repair mechanism involving fibrosis if the appropriate conditions are not found. Skin is one example. Other tissues are not capable of regeneration, and may only undergo repair mechanisms leading to fibrosis and scar formation.
  • the classic model of wound healing may be divided into three or four sequential, yet overlapping, phases: (1) hemostasis, (2) inflammatory. (3) proliferative and (4) remodeling.
  • the proliferative phase is characterized by angiogenesis, collagen deposition, granulation tissue formation and re-epithelialization.
  • Angiogenesis occurs at the same time as fibroblast proliferation. Angiogenesis is imperative for other stages in wound healing because the activity of fibroblasts and epithelial cells requires oxygen and nutrients. According to the process, stem cells of endothelial cells and other vascular cells originating from the circulation and parts of uninjured blood vessels, develop pseudopodia and push through the ECM into the wound site to establish new blood vessels. Endothelial cells are attracted to the wound area by fibronectin found on the fibrin scab and chemotactically by angiogenic factors released by other cells, e.g. from macrophages and platelets when in a low-oxygen environment.
  • endothelial cells need collagenases and plasminogen activator to degrade the clot and part of the ECM.
  • Zinc-dependent metalloproteinases digest basement membrane and ECM to allow cell migration, proliferation and angiogenesis.
  • migration and proliferation of endothelial cells is reduced.
  • blood vessels that are no longer needed die by apoptosis.
  • Collagen production and deposition is important because it increases the strength of the wound by providing more resistance to force than a fibrin-fibronectin clot. Also, cells involved in inflammation, angiogenesis, and connective tissue construction attach to, grow and differentiate on the collagen matrix laid down by fibroblasts. Type III collagen and fibronectin are generally beginning to be produced in appreciable amounts at somewhere between approximately 10 hours and 3 days, depending mainly on wound size. Their deposition peaks at one to three weeks. They are the predominating tensile substances until the later phase of maturation, in which they are replaced by the stronger type I collagen. Even as fibroblasts are producing new collagen, collagenases and other factors degrade it.
  • fibroblasts Shortly after wounding, synthesis exceeds degradation so collagen levels in the wound rise, but later production and degradation become equal so there is no net collagen gain. This homeostasis signals the onset of the later maturation phase.
  • fibroblasts mainly migrate and proliferate, while later, as described above, they are the main cells that lay down the collagen matrix in the wound site. Origins of these fibroblasts are thought to be from the adjacent uninjured cutaneous tissue. Initially, fibroblasts utilize the fibrin cross-linking fibers that are formed by the end of the inflammatory phase to migrate across the wound, subsequently adhering to fibronectin.
  • Fibroblasts then deposit ground substance into the wound bed, and later collagen, which they can adhere to for migration, thereby producing the basis for formation of granulation tissue.
  • Granulation tissue functions as rudimentary tissue, and begins to appear in the wound already during the inflammatory phase, two to five days post wounding, and continues growing until the wound bed is covered.
  • Granulation tissue consists of new blood vessels, fibroblasts, inflammatory cells, endothelial cells, myofibroblasts, and the components of a new, provisional extracellular matrix (ECM).
  • ECM extracellular matrix
  • Such components include fibronectin, collagen, glycosaminoglycans, elastin, glycoproteins and proteoglycans. Its main components are fibronectin and hyaluronan, which create a very hydrated matrix and facilitate cell migration. Later this provisional matrix is replaced with an ECM that more closely resembles that found in non-injured tissue. At the end of the granulation phase, fibroblasts undergo apoptosis, converting granulation tissue from an environment rich in cells to one that consists mainly of collagen.
  • Basal keratinocytes from the wound edges and dermal appendages such as hair follicles, sweat glands and sebacious (oil) glands are the main cells responsible for the epithelialization phase of wound healing. They advance in a sheet across the wound site and proliferate at its edges, ceasing movement when they meet in the middle.
  • keratinocytes are stimulated by lack of contact inhibition and by chemicals such as nitric oxide.
  • cells Before they begin to migrate, cells must dissolve their desmosomes and hemidesmosomes, which normally anchor the cells by intermediate filaments in their cytoskeleton to other cells and to the ECM.
  • Transmembrane receptor proteins called integrins which are made of glycoproteins and normally anchor the cell to the basement membrane by its cytoskeleton, are released from the cell's intermediate filaments and relocate to actin filaments to serve as attachments to the ECM for pseudopodia during migration.
  • integrins Transmembrane receptor proteins
  • keratinocytes change shape, becoming longer and flatter and extending cellular processes like lamellipodia and wide processes that look like ruffles.
  • Actin filaments and pseudopodia form.
  • integrins on the pseudopod attach to the ECM, and the actin filaments in the projection pull the cell along.
  • the interaction with molecules in the ECM through integrins further promotes the formation of actin filaments, lamellipodia, and filopodia.
  • Epithelial cells climb over one another in order to migrate. This growing sheet of epithelial cells is often called the epithelial tongue. The first cells to attach to the basement membrane form the stratum basale. These basal cells continue to migrate across the wound bed, and epithelial cells above them slide along as well. The more quickly this migration occurs, the less of a scar there will be.
  • Fibrin, collagen, and fibronectin in the ECM may further signal cells to divide and migrate.
  • migrating keratinocytes use the fibronectin cross-linked with fibrin that was deposited in inflammation as an attachment site to crawl across.
  • keratinocytes migrate, they move over granulation tissue but underneath the scab (if one was formed), separating it from the underlying tissue.
  • Epithelial cells have the ability to phagocytose debris such as dead tissue and bacterial matter that would otherwise obstruct their path. Because they must dissolve any scab that forms, keratinocyte migration is best enhanced by a moist environment, since a dry one leads to formation of a bigger, tougher scab.
  • keratinocytes To make their way along the tissue, keratinocytes must dissolve the clot, debris, and parts of the ECM in order to get through. They secrete plasminogen activator, which activates plasminogen, turning it into plasmin to dissolve the scab.
  • MMPs matrix metalloproteinases
  • Keratinocytes themselves also produce and secrete factors, including growth factors and basement membrane proteins, which aid both in epithelialization and in other phases of healing. Growth factors are also important for the innate immune defense of skin wounds by stimulation of the production of antimicrobial peptides and neutrophil chemotactic cytokines in keratinocytes.
  • Keratinocytes continue migrating across the wound bed until cells from either side meet in the middle, at which point contact inhibition causes them to stop migrating. When they have finished migrating, the keratinocytes secrete the proteins that form the new basement membrane. Cells reverse the morphological changes they underwent in order to begin migrating; they reestablish desmosomes and hemidesmosomes and become anchored once again to the basement membrane. Basal cells begin to divide and differentiate in the same manner as they do in normal skin to reestablish the strata found in re-epithelialized skin.
  • Wound healing and in particular, tissue regeneration is influenced by a range of factors and conditions. When these factors or conditions are not available, the outcome may be tissue repair and fibrosis instead of regeneration, chronic inflammation and/or ulceration. Examples of relevant factors include local factors, such as the type, size and location of the wound, and systemic factors such as adequacy of vascular supply, presence of infection, movement and metabolic status.
  • the invention seeks to address one or more of the above mentioned needs, or to provide an improvement in wound healing and in one embodiment provides a method of healing a wound including:
  • tropoelastin for use in healing a wound, or for use in improving re-epithelialization of a wound, wherein a therapeutically effective amount of tropoelastin is contacted with a wound edge in conditions for enabling a sustained contact of the tropoelastin with the wound edge for a time period for enabling re-epithelialization of the wound.
  • tropoelastin for healing a wound, or for improving re-epithelialization of a wound, wherein a therapeutically effective amount of tropoelastin is contacted with a wound edge in conditions for enabling a sustained contact of the tropoelastin with the wound edge for a time period for enabling re-epithelialization of the wound.
  • tropoelastin in the manufacture of a medicament for healing a wound, or for improving re-epithelialization of a wound, wherein a therapeutically effective amount of tropoelastin is contacted with a wound edge in conditions for enabling a sustained contact of the tropoelastin with the wound edge for a time period for enabling re-epithelialization of the wound.
  • the tropoelastin may be provided for contact with the wound edge, but not the wound bed.
  • the tropoelastin may be provided in monomeric form, or it may be provided in cross linked or non cross linked form.
  • tropoelastin may be blended with a cross-linked hyaluronic acid gel to form a formulation enabling a sustained release of tropoelastin.
  • FIG. 1 (A) schematic of treatment of wounds on pigs. Wounds were either covered with Integra (blue circles) or treated with Integra Dermal Template incorporating 10% rH TE (Elastinised Integra; green circles) or Integra Dermal Template laid over a 4% rH TE Hydrogel (yellow circles).
  • FIG. 2 biopsy section stained with VVG from a site treated with Elastinised Integra showing the presence of fibroblast cells, new collagen deposition and the presence of elastin fibers.
  • FIG. 3 comparison of different types of dermis observed in VVG stained core biopsy samples taken two weeks post-surgery.
  • FIG. 4 tissue section from wound site treated with Integra Dermal Template+4% rH TE hydrogel two weeks post-surgery. Elastin fibers can be seen towards the base of the dermis underneath the visible rH TE gel in dermal tissue of what looks to be normal appearance. Dermal tissue of similar appearance was also seen within the rH TE hydrogel.
  • FIG. 5 a comparison of the number of blood vessels in each layer of dermis in core biopsy samples taken 2 weeks post-surgery. Elastinised Integra was compared to the corresponding cranial (cran) or caudal (caud) control Integra Dermal Template alone from the same pig. The VVG-stained core biopsy samples were examined under 100 ⁇ magnification and assessed using ImageJ software. Micrographs were taken at multiple levels in the dermis. The first level of dermis (level 1) was obtained by moving the field of view seen in the camera so that the hypodermis was just out of view, Subsequent levels were obtained by moving the sample 0.5 FOVs (as observed down the microscope) towards the epidermis.
  • level 2 above the hypodermis is 0.5 FOVs (as observed down the microscope) away from the level 1 image.
  • Three images were taken at each level of the dermis: one at either edge of the sample and one in the middle. This method ensured that the images taken at different levels of dermis would not contain the same blood vessels, as each FOV down the microscope had a diameter of 2.5 mm, whereas each image as taken by the camera was 650 urn wide.
  • Criteria for blood vessels were: a) lumen size had to be equal to or greater than 10 urn; and, b) the lumen had to be lined by at least 2 cells with dark elongated nuclei. The identity of vessels was sometimes positively confirmed by the presence of blood cells within the lumen, and/or the presence of smooth muscle cells in the tunica media of the vessel wall.
  • FIG. 6 (A) Example of small projections of epidermis into the dermis in a sample treated with Integra only. (B) Example of Rete-like ridges of epidermis in an Elastinised Integra sample.
  • FIG. 7 Recombinant human tropoelastin is proposed to contribute to the wound repair process via chemotactic signalling which contributes to fibroblast & keratinocyte recruitment and vascularization of the regenerated tissue.
  • tropoelastin improves re-epithelialization in full thickness skin wounds.
  • the inventors have found that contact of the tropoelastin with the wound edge in the form of the epidermal cells that form a margin about the wound is critical for improvement in skin re-epithelialization. Critically, where tropoelastin is provided to the wound bed with limited sustained contact with the wound edge, there is little if any improvement in re-epithelialization of the wound.
  • the inventors consider that it is the sustained or persistent contact of tropoelastin with the wound edge or at least persistent placement in the vicinity of the wound edge which provides for the improvements in wound healing seen herein.
  • the various proteases expressed during the wound healing process may generate proteolytic fragments of tropoelastin or facilitate the release of monomers of tropoelastin that favour the various processes of wound healing and tissue regeneration.
  • the examples herein show that these processes include neovascularisation, cell chemotaxis, migration and proliferation and formation of ground substance.
  • the improvements in re-epithelialization are important because from both therapeutic and cosmetic perspectives, it may be critical that a wound is closed with functional epidermal tissue. Where wound closure is not seen, there is a danger that the tissue regeneration process tends to become more akin to tissue repair and fibrosis, leading to the formation of tissue having substandard function and appearance. There is also a danger of chronic inflammation and ulceration.
  • the improvements in epithelialization in terms of extent of re-epithelialization and time to re-epithelialization are significant in this context.
  • a method of healing a wound includes providing an individual having a wound.
  • the wound may arise from any injury to skin tissue. Examples of injury include burn, laceration, abrasion, incision, puncture or rupture.
  • the injury is one which causes breakage, rupture or wounding of the epidermal and dermal layer. It may also cause wounding of tissue underlying the dermis, including subcutaneous tissue, muscle or bone. Thus the wound may be a superficial wound, a partial thickness wound or a full thickness wound.
  • the invention applies to the regenerative processes applying to the dermal and epidermal regions including granulation tissue formation and associated processes including angiogenesis, collagen deposition and the like, and re-epithelialization.
  • the injury may be deliberate, for example surgical, or accidental, for example, trauma.
  • the wound includes a plurality of epidermal cells located about the wound thereby forming a wound edge.
  • the injury will form a wounded region of tissue characterised by an absence of epithelial cells that would normally form an epidermal layer over the region in which the wound is formed.
  • the tissue that is substantially uninjured, and located about the site of the injury generally contains a normal epidermal layer of epidermal cells. It is these cells that are adjacent the wound that form the wound edge.
  • the wound edge or wound margin becomes a site of epithelial cell proliferation during the re-epithelialization process.
  • the wound edge or wound margin is contacted with tropoelastin or elastin-derived fragments in conditions for enabling a sustained contact of the tropoelastin with the wound edge.
  • This is believed to be an important step in the invention.
  • re-epithelialization tends to be observed where the tropoelastin is in contact with, or located in the vicinity of the wound edge.
  • the re-epithelialization may be more complete or naturally structured and the rate of re-epithelialization may be accelerated.
  • the wound bed is generally a dermal tissue surface arising from injury on which granulation tissue is eventually formed in a functional regenerative process.
  • the tropoelastin is provided so that it or various proteolytic fragments thereof are located so close to the wound edge as to readily permit diffusion of tropoelastin or proteolytic fragments thereof for contact with the wound edge.
  • the location of the tropoelastin or elastin-derived fragments thereof, only in or on the wound bed is shown herein not to provide for re-epithelialization as may be observed when the tropoelastin is added to the wound edge. Therefore administration of tropoelastin to the wound bed only is not seen according to the invention as being a location of tropoelastin in the vicinity of the wound edge.
  • the tropoelastin is provided in the form that enables persistent contact with the wound edge.
  • the tropoelastin may be provided in the form of a gel having a viscosity or an adherence which enables the gel, and accordingly, the tropoelastin or fragment therein, to remain in contact with the wound edge.
  • gel formulations include those generally discussed in WO2012068619.
  • the tropoelastin is provided in or on a solid phase, such as a dressing, stent, device or the like which is adapted for sustained contact of the solid phase (and therefore the tropoelastin located in or on the solid phase) with the wound edge.
  • a solid phase such as a scaffold, bulking agent or prosthesis may be placed in the wound bed so that the apical surface of the scaffold is aligned with the wound edge, enabling the tropoelastin or elastin derived peptide in gel format or other to be provided on the apical surface of the scaffold or like in contact with the wound edge.
  • Examples of particular solid phase arrangements include those involving electrospinning of tropoelastin, optionally with other connective tissue molecules such as collagen, and those involving co-precipitation with another connective tissue molecule such as a collagen.
  • the tropoelastin may be provided in a solvent which is sprayed or painted onto the wound edge, and then conditions are provided for evaporation of the solvent from the wound edge, leaving the tropoelastin or fragment thereof in contact with the wound edge.
  • the tropoelastin or elastin derived fragment is typically provided in a therapeutically effective amount. This is generally any amount that results in an improvement in re-epithelialization, in the context of either the extent of re-epithelialization, or time to complete re-epithelialization, as compared with the extent of, or time to re-epithelialization in circumstances where the tropoelastin or elastin derived fragment is not so provided.
  • tropoelastin is provided in a concentration of about 0.1 mg/ml to 250 mg/ml, although this will depend on various factors relevant to the regeneration of skin tissue discussed above. Within this range, the following concentrations may be particularly useful, 1 mg/ml, 25 mg/ml, 50 mg/ml, 100 mg/ml, 150 mg/ml and 200 mg/ml.
  • a method of healing a wound including:
  • the tropoelastin or elastin derived peptides are provided for a time period enabling re-epithelialization of the wound.
  • the time period is generally dependent on the nature of the wound and other factors relevant to tissue regeneration noted above.
  • the wound is a minor acute wound arising from trauma, it may be necessary to provide the tropoelastin in sustained contact with the wound edge for a period of time of no more than about 1 to 2 weeks. This may require a once only application of the tropoelastin. The same may apply where the wound is a clean surgical wound, although this would depend on the size and nature of the wound.
  • the wound is more complex, for example resulting in a substantial loss of dermal tissue or underlying tissue, for example as in a major trauma or chronic injury
  • it may be necessary to provide the tropoelastin according to a dosage schedule for example aligned with the time period during which the wound is routinely dressed and cleaned.
  • a wound bed is generally formed in the dermal layer and may extend to subcutaneous layers or other layers located beneath the dermal layer.
  • a wound bed as generally understood is that surface of normal uninjured tissue, in particular, dermal tissue that is located within the wound.
  • the wound bed may be otherwise defined as that part of the wound in which granulation tissue formation occurs.
  • the wound bed does not generally include epidermal tissue, and therefore the wound bed does not itself contain a ‘wound edge’ as referred to herein.
  • all skin wounds in which the dermal layer has been penetrated (such as a partial or full thickness wound) will have a wound edge and a wound bed.
  • wound edge and ‘wound bed’ are two different concepts.
  • One particular application of the invention described herein is in the remodelling or substantial removal of scar and related fibrotic tissue.
  • scar tissue arises as a consequence of tissue repair.
  • the end result is the formation of a tissue structure that lacks the structure and functional aspects of the relevant tissue in which the scar or fibrosis is located.
  • the finding that with location of tropoelastin or an elastin derived fragment relative to wound architecture described herein it then becomes possible to induce key aspects of tissue regeneration, it then becomes possible to induce a wound and then a wound healing process in scar tissue. Therefore, in another embodiment there is provided a method of minimising scar tissue including:
  • the minimisation of scar tissue refers to removal of scar tissue.
  • the scar tissue is minimised by minimising the volume of, or minimising the abundance of scar tissue in a given region of skin.
  • the wound may be created by various techniques known in the art.
  • One particularly preferred technique involves forming a plurality of micro punctures along the scar tissue so as to create multiple wounds in the scar.
  • the tropoelastin or elastin derived peptide is then provided in sustained contact with the wound edge, or wound bed to enable tissue regenerative processes described herein.
  • the tropoelastin is provided in a form whereby the tropoelastin monomers are not cross linked.
  • tropoelastin in the form of a composition that does not include lysyl oxidase or other cross linking reagent.
  • tropoelastin is provided in form of a composition that does not include amino acid based antioxidants.
  • the tropoelastin for use in the invention is recombinant or synthetic tropoelastin and it is provided in a cell free composition.
  • H&E hematoxylin and eosin
  • VVG Verhoeff-Van Gieson
  • elastin i.e. not rH TE
  • tissue sections from each treatment site were simply scored for the presence or absence of elastin fibers in the repaired dermal tissue.
  • the total number of sections analyzed in the study for Integra Dermal Template alone, Integra Dermal Template plus 4% rH TE hydrogel and Elastinised Integra were 32, 16 and 16, respectively. The results are summarized in Table 1 below.
  • FIG. 3 Examples of the dermal tissue encountered during the analysis of the VVG stained biopsy sections are provided in FIG. 3 .
  • an example of elastin fibers present in dermal tissue adjacent to the rH TE hydrogel is provided in FIG. 4 .
  • the level of vascularization in the regenerated dermis was assessed by histopathology.
  • the number of blood vessels at different levels of the biopsy section tissue was assessed under the microscope, starting with the hypodermis and moving progressively towards the epidermis as described in FIG. 5 .
  • the presence of rH TE in the Integra Dermal Template resulted in an increased number of blood vessels in the regenerated tissue particularly in the direction of the superficial dermis when compared to sites treated with Integra Dermal Template.
  • a similar trend was seen with the sites treated with Integra Dermal Template on top of a 4% rH TE gel.
  • tropoelastin is chemotactic to cells involved in the tissue repair process including monocytes (contribute to neovascularization, differentiate into e.g., fibrocytes) and fibroblasts [Almine et at, 2012].
  • the rH TE gel contains full length tropoelastin monomer which is unmodified and gradually leaches from the gel, supplying tropoelastin that may be utilized by regenerative fibroblasts to construct elastic fibers.
  • Primary human skin fibroblasts utilize rH TE as a substrate for cellular growth and remodel the rH TE into elastin fibers in a process which is dependent on lysyl oxidase (whose activity is inhibited by BAPN) and which results in mature elastin fibers (as evidenced by measurements of elasticity and characteristic fluorescence properties for elastin fibers) [Weiss lab, unpublished data].
  • Pigs were utilized in the current study, each with four, circular, 5 cm diameter, wound sites, two on each side of the animal. For each pig, two wounds from one side were covered with a commercially available skin template product, and two wounds from the other side were treated with either test item A, B or C.
  • Test Item A Electrospun Scaffolds
  • tropoelastin and collagen were combined in a 20% (w/v) protein solution in 1,1,1,3,3,3-hexafluoro-2-propanol (HFP). These included 100% tropoelastin, 80% tropoelastin with 20% collagen, 60% tropoelastin and 40% collagen, 50% tropoelastin and 50% collagen, and 100% collagen. Solutions were loaded into a syringe equipped with a blunt 18 gauge needle and a flow rate of 3 ml h1 was modulated using a syringe pump. The needle was connected to a 20 kV positive power supply and directed at a grounded, 30 mm diameter circular, brass collector at a collector distance of 20 cm.
  • HFP 1,1,1,3,3,3-hexafluoro-2-propanol
  • Electrospun scaffolds were chemically cross-linked to stabilize their structures in aqueous environments. Scaffolds were placed in an open stage desiccator and cross-linked by vapor from a separate 25% (v/v) aqueous glutaraldehyde solution then quenched by immersion into 0.2 M glycine solution overnight. Scaffolds were then washed repeatedly in PBS. See Rnjak-Kovacina, J. et al. Acta Biomater. 2012 October; 8(10):3714-22. This item is significantly more cross linked than Test Item B below. It tends to be more amenable to cellular infiltration.
  • Test Item B Collagen Sponges Incorporating Tropoelastin
  • a white coprecipitate of type I bovine collagen mixed with 10% w/w tropoelastin in 0.05 M acetic acid (pH 3.2) was converted into a highly porous white membrane by freeze-drying. Control of the average pore diameter was achieved by adjusting the initial shelf temperature snap freezing in liquid nitrogen. Subsequent exposure of the dry solid to 105° C. and a 6 kPa vacuum over 24 hr introduced covalent crosslinks between the polypeptide chains of collagen. The construct was immersed in a bath containing 0.25% aqueous glutaraldehyde in 0.05 M acetic acid, and the collagen underwent further covalent crosslinking. The constructs were rinsed in deionized water over 24 hr. See Kanematsu, A., et al. Biomaterials. 2004 August; 25(18):4513-20. This tends to be more resistant to degradation than Test item A above.
  • Test Item C Collagen Sponges with Tropoelastin Gel Underneath
  • Pigs were each treated with up to ten 2 cm ⁇ 2 cm sites across the dorsum. Each site received one of three treatment methods:
  • Photographs and punch biopsies were performed at day 0, 7, and 28. Samples were subjected to histopathology and immunohistochemistry analysis to assess fibroblast infiltration, collagen and elastin deposition, vascularization of the regenerated tissue and regeneration of the epithelium.
  • Fractional laser resurfacing creates vertical channels in the skin approximately 3 mm deep that assists in the delivery of topically applied drugs to the skin.
  • Pigs were each treated with up to ten 2 cm ⁇ 2 cm sites across the dorsum.
  • Each site was treated with a fractional single hole CO 2 laser essentially as described by Haedersdal et al 2010 ( Lasers Surg Med. 42(2):113-22). Subsequent to laser treatment, the test sites received either:
  • Photographs and punch biopsies were performed at day 0, 7, and 28. Samples were subjected to histopathology and immunohistochemistry analysis to assess fibroblast activity, collagen and elastin deposition, vascularization and regeneration of the epithelium.

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